(Wall mount within the Stavanger Acute Medicine Foundation for Education and Research aka SAFER)
One of the main things I wanted to look at when I came to Norway was the difference/similarities between the clinical education content/delivery to that of my own Univeristy. Since I started my nurse training I have been very interested in the comparison of skills needed for practice in the real word, and those taught within the program of study. I personally feel that they do not correspond to each other, and there is work and progress to be made in bringing undergraduate nurse education more into the 21st century.
While many may argue that nursing is an art not a science, I would beg to differ that it is in fact very much both these things. As once described and explained to me by a lecture that I very much admire at my University; with all the good graces of a nurse being kind, caring and compassionate (which I am not dismissing in the slightest they are essential in the profession), those things alone are not going to be able to settle a patient who is attached to a cardiac monitor which starts alarming and gets upset, alarmed or anxious without the nurse being able to interpret the monitor and explain why it may be doing what it is with the sound background of anatomy and physiology in that area. Or in pediatric nursing, how would a nurse explain to parents or the child themselves why they were receiving a certain medication or procedure. It is not always the doctors that are asked the questions and the nurses are often the most available source of information for patients/parents and next of kin. A nurse cannot always keep referring the questions to the doctors. Though of course nurses need to explain and work within the ream of our profession and sphere of competence, they cannot start offering out tip bits of information without the necessary qualifications. Our duty of care extends to ourselves having sufficient enough and up to date knowledge to care for our patients in the safest and most excellent manner.
In Norway one of the things I noticed first is that nursing students here are expected to learn and carry out cannulation in their second year. In the UK this is something most qualified nurses cannot do as it requires you to take an extra training package while you are working. This includes the need of supervision, which given the current climate mostly only doctors and phlebotomists can provide. The time they have to spare in not in great quantities. When I spent some time in the accident and emergency department here in Stavanger, the nursing and medical body were equally surprised that not only are we (as nursing students in the UK) not taught cannulation, we are not even taught the theory in our training either. One of the doctors was very quick to jump in and ask when we then did our cannulation training and I explained that it was not even mandatory on qualification. The puzzled and confused expression in their face more or less said it all. Here in Norway the majority of doctors do not cannulate (they have the option to learn but it is not mandatory), it is seen a nursing role. I have seen the benefit of nurses being able to undertake this skill on the wards as well, as when we are administrating antibiotics for example, and the cannula is not working, or has been removed. There is no time delay or hesitation in it being replaced and the antibiotics going through as the nursing staff can immediately put one back in. Treatments are not delayed, and from my experience in the UK, if a cannula is not working, it is often very difficult to find someone to replace it quickly. This means antibiotics and other medications are delayed and this may have an impact on the effectiveness of the prescribed treatment. I am by no means qualified to state that allowing and teaching nurses within their undergraduate training to cannulate would make the treatment for patients more effective and successful, but you can see the logic and the argument in the implementation. Nursing students here are also able to carry out male cathatrisation, another skill that nurses in the UK can only carry out on qualification with a specific training package.
Simulation training is used a lot more in undergraduate nurse training here than that of the UK. In the first month that I was in Norway I visited Stavanger Acute Medicine Foundation for Education and Research (SAFER) which provides simulation training to nursing students along with all emergency service personnel including the off shore workers on the oil rigs. There is nothing really of this size in the UK though Bristol is home to the Bristol Medical Simulation Center (BMSC), which offers a similar service. In Nottingham, simulation training is not used prominently in undergraduate nurse education, however there is talk that it may be introduced.
In my visit I joined a simulation lesson with other Norwegian nursing students and we carried out a basic refresher of CPR and the use of defibrillators. Afterwards we were split into two groups and put into a simulation room with one of the facilitators controlling the sound/movements/clinical condition of an electronic dummy that was laid out in a mock ward environment. We were fortunate enough that the educators and the majority of the other nursing students had good enough English to be able to attempt the simulation in English! There is a lot of research and studies being published at the moment which look at the use of simulation training and its benefits/suitability to nurse training. So far, much of the research would suggest that simulation in nurse education is beneficial in terms of increasing confidence, transitioning between theory and practice and clinical skills competence. Tough there are still questions which lie around simulations suitability to improving actual patient care. Its use however is on the increase and a number of reasons could be sited for things including a decreasing availability of placement areas and an increase in student numbers, the variations in competence in communication, administration of medicines and decision making among nursing students as found by the Nursing and Midwifery Council (NMC). Finally the increasing challenges nursing educators face in developing and preparing students for the real world of nursing practice the variety of placement/clinical training opportunities available (which can impact on students exposure to certain environments and situations like acute and deteriorating patients), are other reasons that simulation training may become more prominent in future training.
It has been announced recently that there is going to be a review into undergraduate nurse education in the UK. Health Education England along with the NMC are to launch the `State of Caring Review´ in May this year lead by Lord Willis. It comes after the Francis Report highlighted concerns with nurse education and training. It will be interesting to see if the final report which is to be released early 2015, will consider or report on the clinical skills education and delivery along with any mention of need for increased simulation training.